Monday, May 30, 2016

As most of you concluded or have
near-concluded your school year, I spent most of this past week in Court.

Not to worry. . . I was in Court as an
expert witness on a due process hearing for a student who has not received
appropriate services from his school district.

It is an interesting case. . . as well as an
unfortunate example of how some districts refuse to accept their legal
responsibilities to provide services to students with disabilities- -
especially when they don’t really understand why these students sometimes
exhibit some of the frustrating behaviors that are part of their
disability.

Before summarizing the background of this
case, understand that the focus of this week’s Blog is the difference between a
social story and social skills instruction.

This focus came out of the testimony given
by the special education teacher during this week’s due process hearing.Not understanding the difference between
these two intervention approaches, she tried to convince the Hearing Officer
that a social story could successfully teach students (with disabilities) how to
demonstrate more effective interpersonal, social problem-solving, conflict
prevention and resolution, and emotional coping skills.

Social Stories cannot do this - - even
though they are often cited as an important intervention component especially
for students on the autism spectrum.

And that will be the focus here.

_ _ _ _
_ _ _ _ _ _

When Schools Need a Psychological
Consultation

I firmly believe that:

“If
you don’t know, you get a consult.”

It’s a pretty simple concept, and one that
the medical profession has embraced since the beginning of time.

Indeed, the first five lines of the
“modern” Hippocratic Oath are:

“I swear to fulfill, to the best of
my ability and judgment, this covenant:

* I will respect the hard-won scientific gains of those physicians in
whose steps I walk, and gladly share such knowledge as is mine with those who
are to follow.

* I will apply, for the benefit of the sick, all measures which are
required, avoiding those twin traps of overtreatment and therapeutic nihilism.

* I will remember that there is art to medicine as well as science, and
that warmth, sympathy, and understanding may outweigh the surgeon's knife or
the chemist's drug.

* I will not be ashamed to say "I know not," nor will I fail
to call in my colleagues when the skills of another are needed for a patient's
recovery.

_ _ _ _
_

It is this last line that I want to
emphasize today. . . a line that some (many?) educators often do not practice.

This is because:

* This principle is not professionally and
publicly highlighted and celebrated as important in our schools . . .
not just from an ethical perspective, but from an instructional and
intervention integrity perspective.

* Some educators are not encouraged to admit
that they don’t know some things.

[Indeed,
I have worked or consulted in countless schools where administrators create
“professional” cultures and environments where an admission of “not knowing” is
either a tacit admission of incompetence, or a prompt to “simply try harder.”]

* Or- - in today’s virtual, web-based world-
- “not knowing” triggers a Google search, and the potential that the results of
the search (“from about 15,300,000 results. . . 0.28 seconds”) have not been
scientifically vetted, independently proven, or effectively transferred into
the field.

_ _ _ _
_ _ _ _ _ _

Today’s Case

Jonathan is a sixth grade African-American
student who is identified as Emotionally Disturbed (under IDEA), and has mental
health (DSM-V) diagnoses of Reactive Attachment Disorder (RAD) and Attention
Deficit Hyperactivity Disorder (ADHD).He has average intelligence, and is an excellent reader.

Jonathan was addicted to cocaine (through
his mother) at birth, his father has never been present, he was permanently
taken away from his mother before 2 years old, and he continued life in a
series of foster homes- - that changed periodically due to his uncontrollable
behavior.

He spent a “preschool year” in a residential
psychiatric treatment facility, he received early intervention services, and he
was eventually adopted as he entered kindergarten.

Briefly, the clinical conditions for RAD
must be present before Age 5, and they are due to “a pattern of extremes of
insufficient care” that include social neglect or deprivation, repeated changes
of primary caregivers, and rearing in unusual settings that limit the child’s
ability to form consistent, positive, and nurturing attachments.

According to the DSM-V:

“Reactive attachment disorder is characterized
by a pattern of markedly disturbed and developmentally inappropriate attachment
behaviors, in which a child rarely or minimally turns preferentially to an
attachment figure for comfort, support, protection, and nurturance. . . In addition,
(these children’s) emotion regulation capacity is compromised, and they display
episodes of negative emotions of fear, sadness, or irritability that are not
readily explained.”

This pretty well summarizes Jonathan’s
behavior.From early childhood on,
Jonathan’s behavior was characterized by “unpredictable” anger that included
throwing dangerous objects, non-compliance and running away, physical
aggression toward adults and peers, and stealing and swearing.

As a sidebar, the due process case
(eventually headed to federal court) involved the fact that the school district
(a) refused to identify and provide Jonathan services beginning in kindergarten
for his already-identified mental health disability; (b) did not identify him
as Emotionally Disturbed until the beginning of 5th grade; (c) never
provided IEP-driven interventions for him in the classroom, or
cognitive-behavior therapies for him in school; (d) treated his
disability-related behavior as a “discipline problem,” and (e) twice put him on
long-term homebound placements- - again, without providing the social,
emotional, and behavioral supports to address his needs.

_ _ _ _
_ _ _ _ _ _

The Testimony

While the school district never completed an
appropriate functional behavioral assessment or Behavioral Intervention Plan
(BIP), they did acknowledge (just before entering 5th grade) that Jonathan
needed “social skills training.”

After delaying the delivery of this training
for over a year, Jonathan’s new special education teacher decided to meet this
BIP goal in October of his 6th grade year.

However, in testimony at this week’s due
process hearing, this “experienced” special education teacher admitted that:

* She had never been formally trained in
social skills instruction- - especially relative to students with
affectively-based disorders like RAD;

* She developed her own “social skills
curriculum” by pulling a bunch of material “off of the web”;

* She was teaching Jonathan these skills
“whenever she got the chance”; and

* She was using “social stories” as the
foundation to her curriculum; she believed that social stories were evidence-based;
the stories focused on such global constructs as “friendship,” “respect,”
“self-control,” and “handling frustration;” and that she did not pair the
stories with any kind of behavioral instruction or role-playing.

This teacher also stated that she did not
consult with any psychologist or mental health professional- - including
Jonathan’s long-time private clinical social worker- - in the development or
implementation of “her program.”In
fact, she had just purchased a “really good book” that she found on the
internet that had lots of “great social stories for Jonathan.”

The Issue:In addition to her questionable- - if not
unethical - - professional behavior, and her failure to consult with others more
trained and skilled, this teacher lacked the foundational training and
understanding regarding the differences between social stories and social
skills.

_ _ _ _
_ _ _ _ _ _

Social Stories

Social Stories were conceptualized by Carol
Gray in 1991 as a vehicle to improve the social skills of individuals on the
autism spectrum.Often written after a
functional behavioral assessment- - so that they are relevant to a specific
student’s status or needs- - Social Stories are intended to help decrease
inappropriate or establish/enhance appropriate behavior.According to the conceptualization, in order
to be successful, the student needs to both understand and relate to the
content of the story.

Typically, a Social Story describes specific
characters who are in a challenging social situation- - where the story breaks
the resolution of the challenge into specific steps.It includes “who, what, when, where, and why”
questions, and may include both print and pictures.

Social Stories are written in a positive and
reassuring tone, and they may focus on how to (a) analyze a social,
interpersonal, emotional, or conflictual situation; (b) take another’s point of
view, or another perspective of the situation; and (c) resolve the situation
through some behavior, action, or social skill interaction.

It is assumed that, by virtue of hearing, discussing,
and understanding the story, the target student’s behavior and interactions
will improve.

And so, it is critical to note:Unless added by the clinician, the Social
Story methodology does not include behavioral instruction, practice, mastery, or
application.

Think
of the Social Story as the plays in a basketball team’s playbook that are
taught by the coach on the blackboard in the locker room, but are never
practiced to mastery on the actual basketball court during multiple practices.

_ _ _ _
_

What
Does the Research Say
?

Quite simply, the “jury” is still out
relative to the empirical effectiveness of Social Stories and their independent
ability to change students’ behavior.

Indeed, on the National Registry of Evidence-based
Programs and Practices (NREPP) of the U.S. Department of Health and Human
Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), there
is no single evidence-based program that involves or includes Social Stories.

In 2010, two meta-analytic studies on Social
Stories were published.A meta-analysis
is a statistical technique that pools the data from many other well-designed
research studies into a single analysis that summarizes the overall effect of a
specific strategy or intervention.

In one study, Reynhout and Carter analyzed
62 well-designed Social Story studies.They concluded their analysis and paper stating that,

“While
there was considerable variation, on average, Social Stories appear to have
only a small clinical effect on behaviour and practitioners should factor this
consideration into decisions about appropriate interventions”and that

“Social
Stories may be attractive to practitioners because they are easy to implement
and require very limited resources. Nevertheless, given the limited potential
for improvements, in many cases time may be better invested in more intensive
interventions that are likely to yield more substantial gains.”

_ _ _ _
_

In the second study, Kokina and Kern
analyzed 18 Social Story studies involving 47 students.They found that the stories appeared to
either work well or not at all.

Overall, 51% of the individual study outcomes
were classified as “highly effective,” while 44% were considered “ineffective”
and the remaining 4% were considered “questionable” in the behavioral effects.

Kokina and Kern’s conclusions included the
following:

* Social Stories used to reduce
inappropriate behaviors were more successful than those for improving social
skills.

* Stories used to describe single behaviors
were more effective than those describing complex behaviors.

* A child may perfectly understand social
situations (e.g. be able to answer questions about a social situation), but
lack the actual skills to apply their knowledge.

* Stories were more effective when they were
read just before the child had to engage in a target situation, than when the
child was expected to remember and apply the social story to a time-delayed or
unexpected situation.

* Stories that used additional visual
illustrations were more effective than written text alone.

* Studies that first used a functional
behavioral assessment to guide the creation of the social stories were
substantially more successful than those that did not.

* Comprehension checks improved the effectiveness
of the social stories, and children with high levels of communication skills
performed better with social stories than those with low levels.

_ _ _ _
_

Relative to Jonathan and the complexity,
intensity, and history of his social, emotional, mental health, and behavioral
challenges, a Social Story approach by itself was largely
inappropriate.Jonathan needed a
multi-faceted behavioral, clinical, and chemically-enhanced therapeutic
approach to address his 24/7 well-being.

While Social Stories may have increased his
awareness of appropriate behavior, the fact that he did not have the skills
to perform these behaviors were causing such a level of increased frustration
that the strategy was having unintended negative and counterproductive effects.

_ _ _ _
_ _ _ _ _ _

Social Skills Training

There are many evidence-based social skills
curricula:Positive Action, Second
Step, PATHS, and the Stop & Think Social Skills Program-
- which I wrote and help to implement across the country (more information is available at the Stop &
Thinkbelow).

Similar to training a basketball team on
the court to run the specific plays in its playbook, an effective social
skill program teaches the sequential steps and the related behaviors to
specific skills.

For example, in the Stop & Think
Social Skills Program, we sequentially and developmentally teach 20
essential skills at the preschool through Grade 1, Grades 2 to 3, Grades 4 to
5, and Middle/High school levels, respectively . . . skills like:

All of the skills are taught using a social
learning theory approach of Teach, Model, Roleplay and Performance
Feedback, and Transfer of Training.

More
specifically:

When Teaching and Modeling:Teachers need to make sure that students:

* Have the prerequisite skills to be
successful

* Are taught using language that they can
understand

* Are taught in simple steps that ensure success

* Hear the social skills script as the
social skills behavior is demonstrated

_ _ _ _ _

When Practicing or Roleplaying:Teachers need to make sure that students:

* Verbalize (or repeat or hear) the steps to
a particular social skill as they demonstrate its appropriate behavior

* Practice only the positive or appropriate
social skill behavior

* Receive ongoing and consistent practice opportunities

* Use relevant practice situations that
simulate the “emotional” intensity of the real situations so that they can
fully master the social skill and be able to demonstrate it under
conditions of emotionality

* Practice the skills at a developmental
level that they can handle

_ _ _ _ _

When Giving Performance Feedback:Teachers need to make sure that the feedback
is:

* Specific and descriptive

* Focused on reinforcing students’
successful use of the social skill, or on correcting an inaccurate or incomplete
social skills demonstration

* Positive--emphasizing what was done well
and what can be done well (or better) next time_ _ _ _ _

When Transferring or Applying Social
Skills after Instruction:Teachers
need to make sure that they reinforce students’ prosocial skills steps and
behavior when students:

* Have successfully demonstrated an
appropriate social skill

* Have made a “bad” choice, demonstrating an
inappropriate social skill

* Are faced with a problem or situation but
have not committed to, nor demonstrated, a prosocial skill

* Must use the skill in situations that are
somewhat different from those used when the skill was originally taught and
practiced

_ _ _ _ _

What
Does the Research Say
?

The social skills research clearly
demonstrates its effectiveness with students.

In 2011, Durlak and his colleagues published
a meta-analysis involving 213 studies of school-based social, emotional, and behavioral
learning programs involving 270,034 kindergarten through high school students.

When compared with schools that were not
teaching a social skills curriculum, the results indicated that the students
learning these skills demonstrated significantly improved social and emotional
skills, attitudes, and behaviors, and significantly fewer problem behaviors
when compared to control students.

These results occurred at all age levels:elementary, middle school, and high
school.Moreover, these students being
taught these skills demonstrated academic gains that reflected an improvement
of 11 percentile points when compared to the control students.

_
_ _ _ _ _ _ _ _ _

Summary:Back to the Case

Two of my favorite workshop sayings are:

Intervention is a strategic act;
Not a benign act.

and

Every time you do an intervention
that doesn’t work, you potentially make the student more resistant to the next
intervention.

_ _ _ _ _

As uncovered through this due process hearing, Jonathan’s special
education teacher was “practicing” in wholly inappropriate ways.

* She had never been formally trained in
social skills instruction- - especially relative to students with
affectively-based disorders like RAD;

* She did not consult with an expert who
understood the science and practice of social skills instruction, and she did
not have the ability to discriminate what was evidence-based (or not) in the
material she pulled “off of the web”;

* She chose to use a not-yet validated Social
Story approach - - rather than an evidence-based social skills instruction
approach; and

* She may have made Jonathan’s behavioral
problems worse, because he got frustrated when he could not independently use the
information being taught- - given the complexity and history of his challenges.

Regardless of her good intentions, this teacher was unethically
practicing outside her areas of expertise, and her practice was
potentially compounding Jonathan’s challenges and making his more resistant to
future social skill interventions.

As you can tell:I AM critical
of this teacher.But she is not
alone.

Consulting with other experts when we ourselves do not have expertise in
specific areas must be an expected, routine, and celebrated practice.

A Google search just does not cut it. . .for a doctor, a psychologist, or an educator.

End of story. . . all rise. . . Court dismissed.

_ _ _ _ _

While I know the importance of taking a break, please also use your summer
to expand a specific, needed area of knowledge, understanding, or skill.

In
this context, I hope you will process through my message today, reflect on your
current practices (and those within your work setting), and think about ways to
improve. . . on behalf of your students, clients, and others.

You
do not have to agree with everything that has been said here, but your
thoughtful analysis is important.

Meanwhile, I look forward to your thoughts
and comments.Feel free to contact me at
any time.Let me know how I can help
your school, district, regional cooperative, or state move to the “next level
of excellence”- - so that all of the “Jonathans” in our midst receive better,
more effective, and more successful services, support, and interventions.

Connecting with Howie

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About Me

Howard M. Knoff, Ph.D. is the creator and Director of Project ACHIEVE.After 22 years as a university professor and over 12 years as a federal grant director for a state department of education, he continues his national work as a full-time national consultant, author, and presenter.

Dr. Knoff is recognized nationwide as an expert in the following areas:

·School Improvement and
Turn-Around, Strategic Planning and Organizational Development

·Differentiated Academic
Instruction and Academic Interventions for Struggling Students

·Social, Emotional, and
Behavioral Instruction and Strategic and Intensive Interventions for Challenging
Students

·Multi-tiered (RtI)
Services, Supports, and Program

·Effective Professional
Development and On-Site Consultation and Technical Assistance

From 2003 through 2015, he was the Director of the federally-funded State Improvement Grant (SIG; 2003-2009) which then became the State Personnel Development Grant (SPDG; 2009-2015) for the Arkansas Department of Education (ADE). These grants funded the state-wide scale-up of Project ACHIEVE--especially its school improvement, positive behavioral support, and multi-tiered RtI service system components. Through the ADE's Elementary and Secondary Education Act flexibility process, Project ACHIEVE was the state's school improvement model for all Focus schools.

Prior to that, Dr. Knoff was a Professor of School Psychology at the University of South Florida (USF, Tampa, FL) for 18 years, and Director of its School Psychology Program for 12 years. He also was the creator and Director of the Institute for School Reform, Integrated Services, and Child Mental Health and Educational Policy at USF, and was instrumental in leading the program to the accreditation of its doctoral program by the American Psychological Association.

Project ACHIEVE is a nationally-recognized school
effectiveness/school improvement program that has been designated a National
Model Prevention Program by the U. S. Department of Health & Human
Service’s Substance Abuse and Mental Health Services Administration
(SAMHSA).Over the past 30 years, Howie
has implemented Project ACHIEVE components in thousands of schools or school
districts—training in every state in the country.He has also been awarded over $21 million in
federal, state, or foundation grants for this work, and recently received two
School Climate Transformation grants and one Elementary and Secondary
Counseling grant from the federal government to support work in Pennsylvania,
Michigan, and Kentucky.

Dr. Knoff received his Ph.D. degree from
Syracuse University in 1980, and has worked as a practitioner, consultant,
licensed private psychologist, and university professor since 1978.Dr. Knoff is widely respected for his
research and writing on school reform and organizational change, consultation
and intervention processes, social skills and behavior management training,
Response-to-Intervention, and professional issues.

He has authored or co-authored 18 books,
published over 100 articles and book chapters, and delivered over 1,000 papers
and workshops nationally—including the Stop & Think Social Skills
Program (preschool through middle school editions) and the Stop &
Think Parent Book:A Guide to Children’s
Good Behavior through Cambium Learning/Sopris West Publishers and Project
ACHIEVE Press, respectively.

Dr. Knoff has a long history of working
with schools, districts, and community and state agencies and
organizations.For example, he has consulted with a number of state departments of
education, the Department of Defense Dependents School District during Desert
Storm in 1991, and the Southern Poverty Law Center.He has also served as an expert witness in
federal court five times, in addition to working on many other state and local
cases—largely for legal advocacy firms who are representing special education
and other students in need.

Specific to
school safety issues, Dr. Knoff was on the writing team that helped produce Early
Warning, Timely Response:A Guide to
Safe Schools, the document commissioned by President Clinton that was sent
to every school in the country in the Fall of 1998; and he participated in a
review capacity on the follow-up document, Safeguarding our Children: An
Action Guide.

A recipient of the Lightner Witmer Award
from the American Psychological Association's School Psychology Division for
early career contributions in 1990, and over $21 million in external grants
during his career, Dr. Knoff is a Fellow
of the American Psychological Association (School Psychology Division), a Nationally
Certified School Psychologist, a Licensed Psychologist in Arkansas, and he has
been trained in both crisis intervention and mediation processes.Frequently
interviewed in all areas of the media, Dr. Knoff has been on the NBC Nightly
News, numerous television and radio talk shows, and he was highlighted on an
ABC News' 20/20 program on "Being Teased, Taunted, and
Bullied."

Finally, Dr. Knoff was the 21st President of the National Association of
School Psychologists which now represents more than 25,000 school psychologists
nationwide. He is constantly sought after for his expertise in a wide variety of school,
psychological, and other professional issues. You can e-mail him at: knoffprojectachieve@earthlink.net